These are quotes from Freud's case study of Dr. Daniel Schreber, which I find illuminating in reference to Lanark.

"Since paranoiacs cannot be compelled to overcome their internal resistances, and since in any case they only say what they choose to say, it follows that this is precisely a disorder in which a written report or a printed case history can take the place of personal acquaintance with the patient. For this reason I think it is legitimate to base analytic interpretations upon the case history of a patient suffering from paranoia (or, more precisely, from dementia paranoides [paranoid schizophrenia]) whom I have never seen, but who has written his own case history and brought it before the public in print." (84)

"The medical report laid stress upon two points as being of chief importance: the patient's assumption of the role of Redeemer, and his transformation into a woman." (93)

"The attitude of our patient towards God is so singular and so full of internal contradictions that it requires more than a little faith to persist in the belief that there is nevertheless 'method' in his 'madness.'" (97)

"By no means infrequently he himself presses the key into our hands, by adding a gloss to some delusional proposition in an apparently incidental manner, or by making a quotation or producing an example in connection with it, or even by expressly denying some parallel to it that has arisen in his own mind. For when this happens, we have only to follow our usual psychoanalytic technique (to strip his sentence of its negative form, to take his example as being the actual thing, or his quotation or gloss as being the original source) and we find ourselves in possession of what we are looking for -- a translation of the paranoic mode of expression into the normal one." (110-11)

"It will no be possble to define the proper limits of justifiable interpretation until many experiments have been made and until the subject has become more familiar." (112)

"Of the actual nature of Flechsig's enormity and of the motives with which he perpetrated it the patient speaks indefinitely and unintelligibly. Such characteristic vagueness and obscurity, if it is legitimate to judge paranoia upon the model of a far more familiar mental phenomenon -- the dream --, may be regarded as signs of an especially intense activity on the part of the forces engaged upon the construction of the delusion." (113-14)

"It appears that the person to whom the delusion ascribes so much power and influence, in whose hands all the threads of the conspiracy converge, is either, if he is definitely named, identical with some one who played an equally important part in the patient's emotional life before his illness, or else is easily recognizable as a substitute for him. The intensity of the emotion is projected outwards in the shape of external power, while its quality is changed ino the opposite. The person who is now hated and feared as a persecutor was at one time loved and honoured. The main purpose of the persecution constructed by the patient's delusion is to serve as a justification for the change in his emotional attitude." (116)

"We will appeal to the distinction he himself draws between the man Flechsig and the 'Fleschsig soul.' We are not making reproaches of any kind against him -- whether for having had homosexual impulses or for having endeavoured to suppress them. Psychiatrists should take a lesson from this patient, when they see him trying, in spite of his delusions, not to confuse the world of the unconscious with the world of reality." (119)

"The patient's friendly feelings towards his physician may very well have been due to a process of 'transferrence,' by means of which an emotional cathexis became transposed from some person who was important to him, on to the physician who was in reality indifferent to him; so that the physician will have been chosen as a deputy or surrogate for some one much closer to the patient." (122)

"Paranoia decomposes just as hysteria condenses. Or rather, paranoia resolves once more into their elements the products of the condensations and identifications which are effected in the unconscious. [...] Jung is probably right when he goes on to say that this decomposition follows the general lines taken by schizophrenia in that it uses a process of analysis in order to produce a watering-down effect, and is thus designed to prevent the occurrence of unduly powerful impressions." (125)

"[W]e are reminded of the assertion in my Traumdeutung that absurdity in dreams expresses scorn and derision. Evidently, therefore, it is used for the same purposes in paranoia." (128)

"The distinctive character of paranoia (or of dementia paranoides) must be sought for [...] in the particular form assumed by the symptoms; and we shall expect to find that this is determined, not by the nature of the complexes themselves, but by the mechanism by which the symptoms are formed or by which repression is brought about." (135)

"The mechanism of symptom-formation in paranoia requires that internal perceptions, or feelings, shall be replaced by external perceptions. Consequently the proposition 'I hate him' becomes transformed by projection into another one: 'He hates (persecutes) me, which therefore will justify me in hating him.'" (139)

"The delusion of jealousy contradicts the subject, delusions of persecution contradict the verb, and erotomania contradicts the object." (141)

"The most striking characteristic of symptom-formation in paranoia is the process which deserves the name of projection. An internal perception is suppressed, and, instead, its content, after undergoing a certain degree of distortion, enters consciousness in the form of an external perception." (142)

"The third phase, and the most important as regards pathological phenomena, is that of miscarriage of repression, of irruption, of return of the repressed. This irruption takes its start from the point of fixation, and it involves a regression of the libidinal development to that point." (144)

"At the climax of his illness, under the influence of visions which were 'partly of a terrifying character, but partly, too, of an indescribable grandeur,' Schreber became convinced of the imminence of a great catastrophe, of the end of the world. Voices told him that the work of the past 14,000 years had now come to nothing, and that the earth's allotted span was only 212 years more; and during the last part of his stay in Prof. Flechsig's sanatorium he believed that that period had already elapsed. He himself was 'the only real man still surviving,' and the few human shapes that he still saw -- the physician, the attendants, the other patients -- he explained as being 'men miracled up, cursory contraptions.' Occasionally the converse current of feeling also made itself apparent; a newspaper was put into his hands in which there was a report of his own death, he himself existed in a second, inferior shape, and in this second shape he one day quietly passed away." (144-45)

"The patient has withdrawn from the persons in his environment and from the external world generally the libidinal cathexis which he has hitherto directed on to them. Thus all things have become indifferent and irrelevant to him, and have to be explained by means of a secondary rationalization as being 'miracled up, cursory contraptions.' The end of the world is the projection of this internal catastrophe; for his subjective world has come to an end since he has withdrawn his love from it. [...] And the paranoiac builds it up again, not more splendid, it is true, but at least so that he can once more live in it. He builds it up by the work of his delusions. The delusion-formation, which we take to be a pathological product, is in reality an attempt at recovery, a process of reconstruction. Such a reconstruction after the catastrophe is more or less successful, but never wholly so; in Schreber's words, there has been a 'profound internal change' in the world. But the man has recaptured a relation, and often a very intense one, to the people and things in the world, although the relation may be a hostile one now, where formerly it was sympathetic and affectionate." (146-47) (thoughts)